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Identification and Remediation of Environmental Exposures in Patients With Interstitial Lung Disease

Evidence Review and Practical Considerations
Published:February 17, 2021DOI:https://doi.org/10.1016/j.chest.2021.02.021
      A relationship between inhalational exposure to materials in the environment and development of interstitial lung disease (ILD) is long recognized. Hypersensitivity pneumonitis is an environmentally -induced diffuse parenchymal lung disease. In addition to hypersensitivity pneumonitis, domestic and occupational exposures have been shown to influence onset and progression of other ILDs, including idiopathic interstitial pneumonias such as idiopathic pulmonary fibrosis. A key component of the clinical evaluation of patients presenting with ILD includes elucidation of a complete exposure history, which may influence diagnostic classification of the ILD as well as its management. Currently, there is no standardized approach to environmental evaluation or remediation of potentially harmful exposures in home or workplace environments for patients with ILD. This review discusses evidence for environmental contributions to ILD pathogenesis and draws on asthma and occupational medicine literature to frame the potential utility of a professional evaluation for environmental factors contributing to the development and progression of ILD. Although several reports suggest benefits of environmental assessment for those with asthma or certain occupational exposures, lack of information about benefits in broader populations may limit application. Determining the feasibility, long-term outcomes, and cost-effectiveness of environmental evaluation and remediation in acute and chronic ILDs should be a focus of future research.

      Key Words

      Abbreviations:

      HAA (high attenuation areas), HP (hypersensitivity pneumonitis), ILD (interstitial lung disease), IPF (idiopathic pulmonary fibrosis), JEM (job exposure matrix), NIOSH (National Institute for Occupational Safety and Health), PCR (polymerase chain reaction), VGDF (vapors, gas, dust, or fumes)
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